Candidate: Dr. Steffani Bailey has her PhD in clinical psychology and is a Research Assistant Professor in the Department of Family Medicine at Oregon Health & Science University. Dr. Bailey has conducted lab-based studies on craving processes, and directed two randomized clinical trials for smoking cessation in community- based populations. She has 19 peer-reviewed publications, with 9 as first author. Dr. Bailey's previous research experience in smoking cessation, the training activities proposed in the K23 application, and her multidisciplinary team of mentors, will provide her with the expertise and guidance necessary to become an independent investigator in primary care smoking cessation research with underserved populations. Research Focus: Electronic health records (EHR) are increasingly being used to prompt health care providers to assess and treat tobacco use, as well as to document that these services were rendered. The United States Congress passed legislation (meaningful use of EHR) that could increase the use of the EHR for both assessing smoking status and providing cessation assistance in clinics serving Medicaid and Medicare patients. EHRs can aid in the ability to track the progress on selected indicators and can be utilized in research to identify important information about subpopulations that are less likely to be getting the standard of care for tobacco use treatment. Although research has shown that EHR use does increase the number of unique patients asked about smoking status, research is mixed on whether use of this technology increases rates of quitting advice or smoking cessation. The study will use quantitative data from OCHIN, a multiple-facility, linked EHR provider, and qualitative data from clinic observations and interviews with health care providers and patients. This mixed-methods study will 1) evaluate whether implementation of Stage 1 Meaningful Use of EHRs for smoking indicators, which includes changes to the EHR vital signs section, increases rates of assessing smoking status and readiness to quit, and smoking cessation assistance, 2) identify patient, provider, and clinic characteristics associated with rates of smoking assessment and delivery of cessation services, and 3) identify factors that promote and hinder smoking cessation treatment in primary care settings through clinic observations and interviews with both health care providers and patients. This research will inform the development of a primary care-based smoking cessation intervention that utilizes health information technology, as well as develop Dr. Bailey's career in primary care research focused on underserved populations. Training goals: Dr. Bailey's training goals include 1) developing an advanced understanding of facilitators and barriers to the assessment and treatment of smoking in federally-qualified health centers (FQHCs), including use of health information technology, 2) increasing her knowledge of health disparities in underserved populations, 3) developing skills in qualitative methodology and mixed methods research, including advanced biostatistical analysis. Environment: Dr. Bailey will undergo her career development in the Department of Family Medicine at Oregon Health & Science University, an organization with significant and longstanding resources for early-career researchers. She has strong institutional and departmental support. Methods: Using EHR data from 21 FQHC primary care clinics, and random effects Poisson regression, Dr. Bailey will evaluate whether implementation of Stage 1 Meaningful Use increases the rates of assessing smoking status and readiness to quit, and providing smoking cessation assistance (Aim 1). Using 2014 EHR data from 69 FQHC primary care clinics, she will conduct logistic generalized estimating equation regression analyses to examine associations between patient, provider, and clinic-level characteristics and rates of the assessment and treatment of smoking (Aim 2). Finally, using qualitative methods, she will identify facilitators and barriers to smoking cessation treatment in FQHCs. She will collect this data through patient and provider interviews and observations of clinics with the highest and lowest rates of smoking cessation assistance (Aim 3). Outcomes: These results will aid in determining whether resources being invested in the meaningful use of EHR are producing any measurable changes and how they might need to be improved. Findings from this study can inform policy and clinical practices, particularly in primary care settings that provide services to underserved populations with higher than average smoking rates. Results from this study will inform the design of a future intervention for smoking cessation in FQHCs that will be proposed in an R01 application during the latter years of the award period.